Health Insurance
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Family Floater Health Insurance
 
Free Health Check
 
#Applicable only for two years Floater plans Free Health check as per details given in the coupon. Note: Acceptance of your proposal would be subject to receipt of complete medical reports (wherever applicable), medical underwriting and realization of full premium amount by the company.
 
We can add the disclaimer. Rest of the details are already covered in the pop-up.
   
CASHLESS
   
Simply use your Health ID Card at any of our 3500+network hospitals and avail cashless service, a boon for those times when you need finance the most.
 
Will be added to the Family Floater Main Page
   
TAX BENEFITS
   
You can avail of tax benefits on your premium paid as per provisions of Section - 80D* of the Income Tax (Amendment) Act, 1961. *Subject to changes in tax laws
   
Will be added to the Family Floater Main Page
   
COVERAGES
   
Covers medical expenses incurred during hospitalization for more than 24 consecutive Hours 30 days pre-hospitalization 60 days post-hospitalization Named advanced technological surgeries & procedures that require less than 24 hours of hospitalization.*
   
Pre-existing diseases can be covered after 4 continuous Years* of coverage with the Company.
   
Conditions Apply
The relevant disclaimer will be added. Details are not required.
   
HOW DO I CLAIM MY INSURANCE?
   
-Following information is edited after Pritam's feedback and will be added on a separate page, which will link to the Claim Tab on the Family Floater webpage.
   
Given below is a basic and indicative Cashless Claim Procedure. To know about specific service provider's/ TPA's claim process click here. Select a hospital from your service provider's network hospital tie-ups. Check the Network Hospitals booklet mailed to you or visit your service provider's website. However, do note that the hospital booklet might not be updated. Your provider may include or exclude hospitals without giving prior information. It is advisable to check the updated list from the website or contact them directly for information.

The claims for Comprehensive Health Insurance are serviced by ICICI Lombard Health Care, ICICI Lombard’s very own claims processing portal. It has always been our endeavor to provide the best of policy and services to our valued customers, ICICI Lombard Health Care is our initiative towards this commitment.

In case of emergency or planned hospitalization, just use your health ID card at ICICI Lombard Health Care network hospitals and avail of cashless service. Call 24-hours-toll-free number 1800-209-8888 for the complete assistance. For treatment in non-cashless hospitals, the claim form should be filled fully after discharge from hospital and sent to ICICI Lombard Health Care office along with following documents in original*
   
Standard list of documents required;
   
1. Claim form duly filled & signed by the insured & doctor
   
2. Original discharge card/ summary & final bill.
   
3. All investigation reports in originals.
   
4. All medicines /lab/ hospital bill in original.
   
5. All payments receipts in original and should be stamped.
   
6. Any other required documents depending upon the case.
   
Disclaimer: Cashless Approval is subject to preauthorization by the company.
*Only expenses relating to hospitalization will be reimbursed as per the policy coverage. Non-medical expenses will not be reimbursed.
   
You can select your service provider to view specific service provider's/ TPA's cashless claim process.
   
ICICI Lombard Health Care
  TTK Healthcare TPA Private Limited(91)
   
  Not sure which is your service provider? Know your Service Provider/TPA
  Please check your policy number to determine your service provider. You can refer to your cashless claim card for your policy number
   
Policy Number Beginning with 4034 & 4063(91)
  If your policy number starts with 4034 or 4063(91),your service provider is either ICICI Lombard Health Care or TTK Health Care Services.
   
  -If the fifth character of your policy number is an 'i', then your service provider is ICICI Lombard Health Care
  E.g: If Policy number reads as 4034i/HAP/25631478/00/000, the service provider is ICICI Lombard Health Care.
   
  -If the fifth character of the policy number is not an 'i', then your service provider is TTK Health Care Services.
E.g.: The Policy Number number reads 4034/HAP/12345678/00/000, then the service provider is TTK
   
Policy Number Beginning with 4015 & 4016
  -If your policy number begins with 4015 or 4016, kindly refer your cashless health card or contact your HR Department for service provider details.
   
ELIGIBILITY
   
First three points already covered. Fourth point will be added.
Enrollment age for the senior most members proposed for insurance is from 5 years to 60 years.
   
Proposer needs to be aged 18 years or above.
   
Children between the age of 3 months to 5 years will be covered under a floater plan only.
   
• Individual(s) proposed for Insurance whose age is 56 years & above have to undergo medical tests at
  ICICI Lombard designated diagnostic centers.
   
EXCLUSIONS
   
Should only the Permanent Exclusions be featured on this page?
   
• Any illness/ disease/ injury/pre-existing before the inception of the policy. However this exclusion
  ceases to apply if the policy is renewed with the Company for 4 consecutive years.
   
Non-allopathic treatment, Pregnancy & Childbirth-related diseases, cosmetic aesthetic & obesity-related
  treatment.
   
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating
  substances or drugs as well as intentional self injury
   
• Any medical expenses incurred during the first 30 days of inception of the policy, except those arising
  out of accidents. This exclusion doesn’t apply for subsequent renewals with company without a break.
   
Congenital disease
   
War, riot, strike, nuclear weapons induced hospitalization
   
TERMS OF RENEWABILITY (this should be incorporated after EXCLUSIONS FIRST TWO YEARS)
   
  Will include this point in the FAQs section. The content will show in a pop-up window (91).
   
A The policy can be renewed under the then prevailing Family Floater Health Insurance Plan or its
  nearest substitute approved by IRDA in the event that the plan has been discontinued.
   
B Renewal Premium - Premium payable on renewal and on subsequent continuation of cover are
  subject to change with prior approval from IRDA.
   
C Maximum Entry Age – The maximum entry age under this policy is 60 years.
   
D Maximum Renewal Age – This policy can be renewed up to a maximum age of 70 years.
   
E Floater Benefit – The floater benefit under this policy is available up to the age of 60 years. All the
  insured above age of 60 years will be renewed under an individual plan.
   
F Grace Period - The Policy may be renewed by mutual consent and in such event the renewal premium
  shall be paid to the Company on or before the date of expiry of the Policy and in no case later than 15 days (Grace Period) from the expiry of the Policy. However, the Company shall not be liable for any claim for the period for which premium is not received by the Company.
   
G Cumulative Bonus - An Additional Sum Insured of 5% would be provided on cumulative basis on each
  renewal up to a maximum of 50% in case their is no claim under the policy. However, 10% of the Sum Insured will be reduced from the accumulated Additional Sum Insured, in case there is a claim under the policy.
   
H Sum Insured Enhancement – Sum Insured can be enhanced only upon renewal, subject to
  underwriters' approval.
   
I Inclusion / Exclusion of Insured – This policy allows to include or exclude a member in the plan only at
  the time of renewal.
   
J Loading in case of Claims – The renewal premium shall be calculated as per the age of the senior
  most insured member as covered under the policy. A loading may be charged on the premium in case there is a claim in the expiring policy. The loading of premium is calculated as per the following
   
  scale :
   
i In case of claim not pertaining to chronic Illness –
   
 
Claim Amount (Rs.) Loading
   
0 - 25,000 Nil
25,001 - 50,000 10%
50,001 - 100,000 20%
100,001 - 200,000 50%
>200,000 75%
  For subsequent renewals, there will be no loading unless there is a claim in any renewal policy.
   
ii In case of claim pertaining to chronic illness like heart diseases, cancer, brain diseases, organ failure
  and cirrhosis of the liver, loading of 75% on the base premium will be applicable. The loading will be applicable for all subsequent renewals. If there are claims in the subsequent renewals , further loading o f75% would be applicable, subject to a maximum of 200% on the base premium
   
  The extent of loading thus derived would be applicable for all subsequent renewals.
   
  For the purpose of determination of loading on renewal policies, chronic ailments mean any condition or Illness which is normally prolonged or recurrent, including but not limited to heart diseases, cancer, brain diseases, organ failure and cirrhosis of the liver.
   
 

Customer Information Sheet

Product Description - This is illustrative and not exhaustive

 

 

 
S. NO TITLE DESCRIPTION

REFER TO POLICY
CLAUSE NUMBER

1 Product
Name
Family Protect Premier  
2 What am
I covered
For
Hospital admission longer than 24 hrs
   
Related medical expenses incurred 30 days prior
  to hospitalization
   
Related medical expenses incurred within 60
  days from date of discharge
   
Specified / Listed procedures requiring less than
  24 hours of hospitalization
   
Pre-existing diseases covered after 4 Years of
  continuous coverage
   
Convalescence Benefit of Rs. 10,000 provided
  once during policy period, in case of hospitalization of 10 days or more
   
Hospital Daily Allowance the insured shall be
  given Rs 1000 per day for hospital stay of 5 days or more upto a maximum of Rs 7000.
   

Part II of schedule
Clause 2. Scope of the Cover

 

Part II of schedule definition of Specified Treatment
Part II of schedule Clause 3.1
Part III of schedule Extension HC 18- Convalescence Benefit
Extension HC 08- Hospital Daily allowance

3 What are the major
exclusion
s in the
policy
Any hospital admission primarily for investigation /
  diagnostic purpose
   
Pregnancy, infertility, congenital diseases
   
Non-allopathic medicine, Unproven experimental
  treatment
   
Domiciliary treatment, treatment outside India
   
Cosmetic surgery
   
Dental treatment unless due to accident
   
Refractive error correction, hearing impairment
  correction
   
Substance abuse, self-inflicted injuries, STDs
  and HIV / AIDS
   
Hazardous sports, war, terrorism, civil war or
  breach of law
   
(Note: the above is an indicative list of the policy exclusions. Please refer to the policy clauses for the complete list)
   
   
Part II of schedule
Clause 3.4 Permanent Exclusions
4 Waiting
Period
Initial waiting period: 30 days for all illnesses (not
  applicable on renewal or for accidents)
   
Specific waiting periods :
   
 
First 24 months, for treatment of certain
  diseases like cataract, hernia, sinusitis, stones (this is a partial listing. Please refer to the policy clauses for the full listing)
   
Pre-existing diseases: Covered after 48 months
  of continuous coverage with us under this policy
   
   

Part II of schedule
Clause3.2

Clause3.3

Clause3.1

5 Payout
Basis
Reimbursement of covered medical expenses up
  to the specified Sum Insured as per the scope of cover
   
Fixed lump-sum amount of Rs. 10,000 once
  during the policy period, in case of hospitalization of 10 days or more
   
Hospital Daily Allowance the insured shall be
  given Rs 1000 per day for hospital stay of 5 days or more upto a maximum of Rs 7000
   
Cashless Facility available at over 3500+ network
  hospitals
   
Part II of schedule
2. Scope of the Cover
HC 18- Convalescence Benefit
Extension HC 08- Hospital Daily allowance
6 Cost
sharing
No co-payments or sub-limits; except in case of Cataract, where sub-limit of Rs 20000/- is applicable per eye Part II of schedule
6. Payment of Claims
7 Renewal
Condition
Maximum Renewal age - This policy is ordinarily
  renewable up to age of 70 years
   
Grace Period - The renewal premium shall be
  paid to Us on or before the date of expiry of the Policy and in no case later than 15 days (Grace Period) from the expiry of the Policy
   
Floater Benefit - The floater benefit under this
  policy is available up to the age of 60 years. All Insureds above 60 years of age will be renewed under individual plans
   
Inclusion/Exclusion of insured - This policy allows
  inclusion / exclusion of an insured only at the time of renewal of the policy
   
Loading in case of claims – The renewal
  premium is calculated as per the age of the senior most insured member covered under the policy. This premium may be loaded in case of a claim under the policy. Loading will be as per the scale mentioned in the policy
Part III of schedule
19. Renewal notice
8 Renewal
Benefits:
Cumulative Bonus (Additional Sum Insured) - An Additional Sum Insured of 5% provided on each renewal for every claim-free year upto a maximum of 50% policy. In case of a claim under the policy, the accumulated Additional Sum Insured will be reduced by 10% in the following year Part III of schedule
Extension HC 06- Cumulative Bonus
9 Cancellation The policy can be cancelled by either of the parties by giving 15 days written notice.

In case you cancel the policy, the premium will be refunded on short term rates for the unexpired policy period

In case the policy is cancelled by the Company, the premium will be refunded on pro-rata basis for the unexpired policy period

This policy would be cancelled, and no claim or refund would be due to you if:

you have not correctly disclosed details about your current and past health status OR

have otherwise encouraged or participated in any fraudulent claims under the policy
Part III of schedule
1. Incontestability & Duty of Disclosure
14. Fraudulent claims
15. Cancellation/ termination
  (LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the CIS and the policy document the terms and Conditions mentioned in the policy document shall prevail.
   
Family Protech One Year
   
   
   
Family Protech Two Year